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Rumours and Riots: Local Responses to Mass Drug Administration for the Treatment of Neglected Tropical Diseases Among School-Ag

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Rumours and Riots: Local Responses to Mass Drug Administration for the Treatment of Neglected Tropical Diseases Among School-Ag Rumours and riots: Local responses to mass drug administration for the treatment of neglected tropical diseases among school-aged children in Morogoro Region, Tanzania A thesis submitted for the degree of Doctor of Philosophy by Julie Dawn Hastings Department of Anthropology School of Social Sciences Brunel University January 2013 Abstract In August 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases – schistosomiasis haematobium and soil- transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents and guardians rushed to schools to prevent their children taking the drugs when they heard reports of children dying in Morogoro town after receiving treatment. When pupils heard these reports, many of those who had swallowed the pills began to complain of dizziness and fainted. In Morogoro town hundreds of pupils were rushed to the Regional Hospital by their parents and other onlookers. News of these apparent fatalities spread throughout the region, including to Doma village where I was conducting fieldwork. Here, protesting villagers accused me of bringing the medicine into the village with which to “poison” the children and it was necessary for me to leave the village immediately under the protection of the Tanzanian police. This thesis, based on eleven months fieldwork between 2007 and 2010 in Doma village and parts of Morogoro town, asks why was this biomedical intervention so vehemently rejected? By analysing local understandings and responses to the mass distribution of drugs in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was a considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture, fuelled by the reports of fatalities and the pupil’s fainting episodes brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro town, there was suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by “ignorant” people. However, from an anthropological perspective, these ‘rumours’ reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world. The thesis also shows that many of the assumptions embedded in global policies seeking to control neglected tropical diseases are mistaken. Indeed, it is suggested that it is unlikely that schistosomiasis haematobium and soil- transmitted helminths will be controlled so long as policy makers persist with the idea that one policy, designed by staff working for the World Health Organisation – with minor modifications added in Dar es Salaam - can be rolled out uniformly, irrespective of the political, social and economic context in which the programme occurs. ii Contents List of maps and figures.................................................................................................. vi Figures ........................................................................................................................... vi Acknowledgments ........................................................................................................ viii Selected Kiswahili glossary and phrases........................................................................ xiii Abbreviations and acronyms ......................................................................................... xx Chapter 1: Introduction ..................................................................................................1 Drug distribution in Doma village.............................................................................7 The official explanation ......................................................................................... 12 Alternative explanations ........................................................................................ 13 Methods ....................................................................................................................... 15 Comings and goings: Reflections on multi-sited, multi-visited fieldwork ........................ 22 Ethical considerations ............................................................................................ 26 Thesis outline ........................................................................................................ 26 Chapter Two: Biomedical perspectives of schistosomiasis and soil-transmitted helminths ..................................................................................................................... 32 Schistosomiasis ..................................................................................................... 32 Soil-transmitted helminths .................................................................................... 37 Neglected Tropical Diseases and the Millennium Development Goals .................... 38 The biomedical rationale for mass drug administration ......................................... 41 Controlling schistosomiasis and soil-transmitted helminths in Tanzania ................. 42 Questioning the merits of mass treatment for neglected tropical diseases .................... 44 Chapter Three: Contextualizing the field ...................................................................... 49 Tanzania ....................................................................................................................... 49 German and British colonialism (1885 – 1961) .............................................................. 59 Islam and Christianity .................................................................................................... 61 Aspects of independence .............................................................................................. 64 Towards independence: The rise of TANU and Nyerere .................................................. 64 Uhuru na Ujamaa (freedom and socialism) ................................................................... 65 Villagization .................................................................................................................. 65 Multi-party politics ................................................................................................ 67 The legacy of Nyerere and Ujamaa ........................................................................ 68 Colonialism and biomedicine ................................................................................. 70 iii Vampire rumours .................................................................................................. 72 Contemporary blood and organ stealing rumours ......................................................... 74 Poisoned children: New rumours for new times? ................................................... 76 Chapter 4: “Somehow we survive”: Precarious lives in Doma village and Chamwino ‘squatter’ area .............................................................................................................. 78 Morogoro town ..................................................................................................... 79 Chamwino 'squatter' area...................................................................................... 84 Doma village.......................................................................................................... 88 Daladala sentiments .............................................................................................. 93 Chapter 5: Misfortune, illness, healing and protection ................................................. 97 Part I: Misfortune, Illness and Healing ........................................................................... 98 Misfortune & Illness .............................................................................................. 98 Healing ................................................................................................................ 107 Part II: Protecting against illness in young children: Vaccinations (chanjo) & amulets (kidusa/fubala) ............................................................................................................ 123 Conclusion .................................................................................................................. 139 Chapter Six: Local understandings of kichocho and minyoo ....................................... 140 Prevalence of Schistosoma haematobium and soil-transmitted helminths ........... 141 Local understandings of kichocho ........................................................................ 142 Local understandings of minyoo .......................................................................... 149 Kichocho and minyoo are just part of life ..................................................................... 150 Seeking treatment for kichocho and minyoo ........................................................ 150 Conclusion .................................................................................................................. 157 Chapter Seven: Dilemmas in the delivery of mass treatment ..................................... 159 Informing parents and pupils ..............................................................................
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